Single-payer system rises on horizon

The president has predicted that Obamacare will explode this year. If it does, as conservative columnist Charles Krauthammer recently noted, its replacement may well be a single-payer national health insurance system. To that we would say, “It’s about time.”

Germany created its national health care system in 1883, Great Britain in 1911. The following year former president Teddy Roosevelt, running on the Bull Moose ticket, proposed a similar system, albeit for low-wage workers.

It scarcely seems possible that a stupendously dysfunctional, hyper-partisan Congress and a petulant president could do something as monumental as enacting Medicare for all, which is what bills filed in the House and Senate would do. But if Obamacare collapses, tens of millions of Americans would become uninsured. They will be angry.

Look at the list of the states with the highest percentage of uninsured, the ones that would benefit most by Medicare for all. Texas tops the list at 16 percent, followed by Georgia, Alabama, Arizona, Florida, Mississippi and Oklahoma. Trump carried all of them. He also carried states that took advantage of the Affordable Care Act’s option to expand Medicaid. Voters there would be even angrier.

“Obamacare may turn out to be unworkable, indeed doomed, but it is having a profound effect on the zeitgeist: It is universalizing the idea of universal coverage,” Krauthammer wrote. “Acceptance of its major premise – that no one be denied health care – is more widespread than ever.”

Indeed it is. Last year a Gallup poll found 58 percent support for a single-payer system, and that was before Republicans failed to repeal and replace Obamacare. “The arc of the moral universe is long,” Dr. King said, “but it bends towards justice.”

Health care spending consumes nearly 18 percent of the economy but much of that spending – estimates are in the 30 percent range – does nothing to improve the health of the American people, whose life expectancy actually fell in 2015, according to the Center for Health Statistics. The death rate for white, working-class voters – Trump voters – rose the most dramatically. Meanwhile, the system wastes money that could be spent to combat substance abuse, obesity and other preventable killers.

Hospitals and other providers spend billions to “code” bills to inflate them and maximize revenue. Insurance companies, lawyers and federal employees do the same to dispute those bills. None of it does anything to improve health.

A single-payer system, one that negotiates with providers and drug companies to get the best deal, would eliminate that waste and save a fortune. But it would do much more. It would stimulate entrepreneurship by ending job lock – people who remain in jobs only because they need insurance. It would free employers from the burden of providing health insurance, lift the threat of bankruptcy by medical bill and eliminate an enormous source of stress imposed on all players, employers, doctors, patients and family members.

The most ideologically conservative Republicans are implacably opposed to government paying for health care, which is what every other developed nation does. Others, especially those representing states that have benefited greatly from expanded Medicaid, may not be so intractable. Trump, during one presidential debate, indirectly supported a single-payer system, saying “it works in Canada. It works incredibly well in Scotland.”

It took Nixon to go to China. It may take Trump, to establish universal health insurance. Krauthammer thinks it could happen. “A broad national consensus is developing that health care is indeed a right. This is historically new. … It suggests that we may be heading inexorably to a government-run, single-payer system.”